Project summary/Abstract Spina bifida is a major congenital anomaly of the spinal cord and the associated vertebrae. About 1645 infants are born each year in the United States with this anomaly. This spinal cord lesion has numerous deleterious effects on the neurologic, orthopedic and urologic systems. Urological evaluation of infants with spina bifida begins at birth. In order to understand the most appropriate way to better understand the optimal urologic management of infants with spina bifida was to institute a multi-institutional trial utilizing a ?best practices? approach. This trial, The Urologic Management to Preserve Initial Renal Function Protocol for young Children with Spina Bifida? (UMPIRE protocol) is now in its fifth year. The purpose of this project in the next 5 years of patient enrollment will be to correlate data with specific clinical outcomes including renal function, renal scarring, upper tract deterioration, bladder dynamics, UTI?s, continence, and need for surgical intervention. These findings will allow one to then better define changes that need to be made to the best practices protocol to better achieve the optimal urologic management of these individuals.